Although many mental health professionals regard managed care strategies as unwelcome intrusions into clinical affairs, it should be recognized that from the point of view of corporations, the payers in most cases, these strategies are alternatives to financially-based strategies to reduce costs, such as demand-side cost sharing in the form of day limits on covered services or supply-side cost sharing in the form of prospective payment. These financial tools for cost control have received a great deal of research attention. Managed care strategies are new and much less is known about their impact. Two specific strategies, prior approval for impatient admission and concurrent review of impatient admissions, are the subject of this study. The strategies differ in their relative intrusiveness in the physician- patient relationship, in the price to corporate clients and in the underlying assumptions about the delivery of psychiatric and substance abuse care which drive the structure and the presumed effect of the interventions. The proposal has two specific aims: 1. To compare the patterns of utilization of impatient services before and after the introduction of two specific types of mental health managed care interventions intended to reduce utilization (and thereby contain costs) of reimbursed mental health care provided to employees and their dependents. We hypothesize that the more intrusive and active the managed care program, the more likely the use of mental health services will be controlled. The comparison of two types of managed care programs will provide us with a measure of effect: the length of stay and covered charges per admission and per claimant (annually). To explore the relationship in the variance of patterns of utilization and charges, these dependent variables will be regressed on certain factors thought to have some effect on LOS, including the program review variable. 2. To estimate the savings due to managed care. The availability of both impatient and outpatient charge data will permit tests of cost shifting to provide more refined estimates of savings. In addition to our estimation of savings, a number of definitions of "savings" are used in the managed care literature. These will be critiqued and reviewed with comparisons to our approach.